The traditional approach to cancer treatment has been to try to eradicate tumors. Eliminating a tumor is better than shrinking a tumor, so this approach makes sense. But if you try to eradicate the tumor and fail, you may leave the patient worse off. If you kill 90% of a tumor with some treatment but leave 10%, the remaining 10% is resistant to that treatment. You may have made the tumor more deadly by removing the weaker portions that were suppressing its growth. This explains why cancer treatments sometimes appear to be quite successful, dramatically reducing the size of tumors, without improving survival.
Sometimes one treatment will shrink a tumor as much as possible as a prelude to another treatment, such as shrinking a tumor with chemotherapy prior to surgery. But if only one treatment is being used, the situation may be like the old saying that you don’t want to wound the king. If you’re going try to kill the king, you’d better succeed.
In a recent interview on the Nature podcast, Robert Gatenby of Moffitt Cancer Center advocates an alternative approach, treating cancer as a chronic disease. Instead of killing as much of a tumor as possible, it may be better to kill as little of tumor as necessary to keep it under control. Patients would continue to take anti-cancer treatments for the rest of their lives, just as patients with heart disease or diabetes take medication indefinitely.